Jinekolog gözüyle genital tüberküloza global bakış

Ümit Görkem; Sertaç Arslan

Jinekolog gözüyle genital tüberküloza global bakış

Year 2020, Volume: 77 Issue: 2, 253 - 266, 01.06.2020

Abstract

Tüm dünyada tüberküloz TB , milyonlarca insanı etkilemekte ve ölümle sonuçlanan en sık on hastalık arasında yer almaktadır. Günümüzde TB’nin tanı ve etkili tedavi yöntemlerinde gerçekleşen iyileşme ile mortalitede çok önemli düşüşler elde edilmiştir. Buna rağmen, TB hala önemini koruyan bir halk sağlığı problemidir. TB gelişmekte olan ülkelerde hala maternal mortalitenin obstetrik olmayan en sık nedenleri arasındadır. Genital TB GTB infertilite, pelvik ağrı, kronik pelvik enflamatuvar hastalık, disparoni ve anormal uterin kanamaların önemli nedenlerinden biri olarak düşünülmektedir. Dolayısı ile erken tanı, uygun ve etkili tedavi ile GTB’nin klinik olumsuz sonuçları engellenebilir veya en aza indirilebilir. GTB sıklıkla akciğer TB’ye veya böbrek, meninks, iskelet ve gastrointestinal sistemlerdeki akciğer dışı odaklara sekonder olarak gelişir. TB basili genital sistemi sıklık sırasına göre 4 yolla enfekte eder: 1- Hematojen yayılım, 2- Lenfatik yayılım, 3- Desendan direkt yayılım, 4- Seksüel ilişki ile genitalyanın primer enfeksiyonu. Ayrıca, hastalık böbrek yetmezliğinde uygulanan periton diyalizi ile de yayılabilmektedir. GTB’nin etkilediği genital organlar sıklık sırasına göre Fallop tüpleri %90100 , uterin endometriyum , serviks , uterin myometriyum , vulva ve vajendir . TB, genital sistemde tubal hasara ve bozulmuş endometrial reseptiviteye yol açarak infertiliteye neden olmaktadır. İntrauterin yapışıklıklar, menstrüel anormallikler ve bozulmuş endometrial reseptivite ile sonuçlanan endometrium hasarı, tekrarlayan gebelik kayıpları ve ektopik gebelik risklerini artırmaktadır. Ayrıca pelvik kitlelerin değerlendirilmesinde GTB de ayırıcı tanıda göz ardı edilmemelidir. GTB’li infertil hastalarda en gerçekçi tedavi yaklaşımı, gebelik sonuçlarının çok olumlu olmamasına rağmen, endometriumun değerlendirilmesini takiben hastanın yardımla üreme tekniklerine yönlendirilmesi gerekebilmektedir. Yüksek risk popülasyonlarının uygun taranma prosedürleri jinekolojik, obstetrik ve reprodüktif olumsuz sonuçların önlenmesi ve TB eradikasyonu için son derece önem taşımaktadır. Tüm dünyada olduğu gibi Türkiye’de de son yıllarda göçmenlerin sayısı hızlı bir şekilde artmaktadır. Dolayısı ile günümüzde unutulmuş bir hastalık gibi görülen TB klinik pratiğimizde akılda tutulmalıdır

Keywords

Tüberküloz, kadın genital, infertilite, Mycobacterium tuberculosis

References

1. World Health Organization. Facts about health in African Subregion, Fact sheet N◦314 World Health Organisation, 2011.
2. World Health Organization. Global Tuberculosis Report 2018. Geneva: World Health Organization; 2018.
3. Grange J, Adhikari M, Ahmed Y, Mwaba P, Dheda K, Hoelscher M, et al. Tuberculosis in association with HIV/AIDS emerges as a major nonobstetric cause of maternal mortality in Sub-Saharan Africa. Int J Gynaecol Obstet, 2010; 108: 181- 3.
4. Neonakis IK, Spandidos DA, Petinaki E. Female genital tuberculosis: A review. Scand J Infect Dis, 2011; 43(8): 564-72.
5. Sharma JB. Tuberculosis and Gynecological Practice. In: Studd J, Tan SL, Chervenak FA, eds. Current Progress in Obstetric and Gynecology. Mumbai. Tree Life India, 2012: 304-27.
6. Jones HW, Wentz AC, Burnett LS. Novak’s Textbook of Gynecology, 11th ed. Baltimore: 1988.
7. Arora VK. Relevance of DOTS strategy in female genital tuberculosis. Obstet Gynecol Today, 2002; 7: 179-83.
8. Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician, 2005; 72: 1761–8.
9. Margolis K, Wranz PA, Kruger TF, Joubert JJ, Odendaal HJ. Genital tuberculosis at Tygerberg Hospital- Prevalence, clinical presentation and diagnosis. S Afr Med J, 1992; 81(1): 12-5.
10. Saracoglu OF, Mungan T, Tanzer F. Pelvic tuberculosis. Int J Gynaecol Obstet, 1992; 37(1): 115-20.
11. Lawn SD, Zumla AI. Tuberculosis. Lancet. 2011; 378: 57-72.
12. Oosthuizen AP, Wessels PH, Hefer JN. Tuberculosis of the female genital tract in patients attending an infertility clinic. S Afr Med J, 1990; 77(11): 562-4.
13. Sağlık Bakanlığı. Türkiye’de Verem Savaşı 2018 Raporu.
14. Sağlık Bakanlığı. Türkiye’de Verem Savaşı 2011 Raporu.
15. Sharma JB. Current diagnosis and management of female genital tuberculosis. J Obstet Gynaecol India, 2015; 65(6): 362-71.
16. TB India. Revised National Tuberculosis Control Program (RNTCP). Annual Status Report. Central TB Division, Directorate General of Health Services. Nirman Bhawan, New Delhi, India: Ministry of Health and Family Welfare; 2016.
17. Parikh FR, Nadkarni S. Genital tuberculosis- a major pelvic factor causing infertility in Indian women. Fertil Steril, 1997; 67(3): 497-500.
18. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr, 2017; 5(1).
19. Ilhan AH, Durmuşoğlu F. Case report of a pelvic-peritoneal tuberculosis presenting as an adnexial mass and mimicking ovarian cancer, and a review of the literature. Infect Dis Obstet Gynecol, 2004; 12(2): 87-9.
20. Namavar Jahromi B, Parsanezhad ME, GhaneShirazi R. Female genital tuberculosis and infertility. Int J Gynaecol Obstet, 2001; 75(3): 269-72.
21. Sharma JB. In vitro fertilization and embryo transfer in female genital tuberculosis. IVF Lite, 2015; 2(1): 14-25
22. Bose M. Female genital tract tuberculosis: How long will it elude diagnosis? Indian J Med Res, 2011; 134: 13-4.
23. Chowdhury NN. Overview of tuberculosis of the female genital tract. J Indian Med Assoc, 1996; 94(9): 345-6, 361.
24. Raut VS, Mahashur AA, Sheth SS. The Mantoux test in the diagnosis of genital tuberculosis in women. Int J Gynaecol Obstet, 2001; 72(2): 165-9.
25. Lange C, Pai M, Drobniewski F, Migliori GB. Interferon-gamma release assays for the diagnosis of active tuberculosis: Sensible or silly? Eur Respir J, 2009; 33(6): 1250-3.
26. Pai M, Joshi R, Bandyopadhyay M, Narang P, Dogra S, Taksande B, et al. Sensitivity of a whole-blood interferon-gamma assay among patients with pulmonary tuberculosis and variations in T-cell responses during antituberculosis treatment. Infection, 2007; 35(2): 98-103.
27. Saraswat P, Swarankar ML, Bhandari A, Soni RR. Detection of active female genital tuberculosis by molecular method. Int J Pharma Bio Sci. 2010; 1(4).
28. Bhanu NV, Singh UB, Chakraborty M, et al. Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility. J Med Microbiol , 2005; 54(Pt 10): 927-31.
29. Lal N, Soto-Wright V. Peritoneal tuberculosis: Diagnostic options. Infect Dis Obstet Gynecol, 1999; 7(5): 244-7.
30. Straughn JM, Robertson MW, Partridge EE. A patient presenting with a pelvic mass, elevated Ca-125 and fever. Gynecol Oncol, 2000; 77(3): 471-2.
31. Sutherland AM. Gynaecological tuberculosis: analysis of a personal series of 710 cases. Aust N Z J Obstet Gynecol, 1985; 25(3): 203-7.
32. Sharma JB, Pushparaj M, Roy KK, Neyaz Z, Gupta N, Jain SK, et al. Hysterosalpingographic findings in infertile women with genital tuberculosis. Int J Gynecol Obstet, 2008; 101(2): 150-5.
33. Shah HU, Sannananja B, Baheti AD, Udare AS, Badhe PV. Hysterosalpingography and ultrasonography findings of female genital tuberculosis. Diagn Interv Radiol, 2015; 21(1): 10-5.
34. Ahmadi F, Zafarani F, Shahrzad G. Hysterosalpingographic appearances of female genital tract tuberculosis: Part I. Fallopian tube. Int J Fertil Steril, 2014; 7(4): 245-52.
35. Ahmadi F, Zafarani F, Shahrzad GS. Hysterosalpingographic appearances of female genital tract tuberculosis: Part II: Uterus. Int J Fertil Steril, 2014; 8(1): 13-20.
36. Farrokh D, Layegh P, Afzalaghaee M, Mohammadi M, Fallah Rastegar Y. Hysterosalpingographic findings in women with genital tuberculosis. Iran J Reprod Med, 2015; 13(5): 297-304.
37. World Health Organization. Manual of diagnostic ultrasound. Geneva: WHO; 2013.
38. Sharma JB, Roy KK, Pushparaj M, Kumar S, Malhotra N, Mittal S. Laparoscopic findings in female genital tuberculosis. Arch Gynecol Obstet, 2008; 278(4): 359-64.
39. Baxi A, Neema H, Kaushal M, Sahu P, Baxi D. Genital tuberculosis in infertile women: Assessment of endometrial TB PCR results with laparoscopic and hysteroscopic features. J Obstet Gynecol India, 2011; 61(3): 301-6.
40. Koc S, Beydilli G, Tulunay G, Ocalan R, Boran N, Ozgul N, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol, 2006; 103(2): 565-9.
41. Chong VH, Rajendran N. Tuberculosis peritonitis in Negara Brunei Darussalam. Ann Acad Med Singapore, 2005; 34(9): 548-52.
42. Bilgin T, Karabay A, Dolar E, Develioglu OH. Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: a series of 10 cases. Int J Gynecol Cancer, 2001;11(4): 290-4.
43. Kuohung W, Borgatta L, Larrieux JR, Weiss RM. Pelvic tuberculosis diagnosed by hysteroscopy during infertility evaluation. J Assist Reprod Genet, 2000; 17(8): 459-60.
44. Sharma JB, Roy KK, Pushparaj M, Karmakar D, Kumar S, Singh N. Increased difficulties and complications encountered during hysteroscopy in women with genital tuberculosis. J Minim Invasive Gynecol, 2011; 18(5): 660-5.
45. World Health Organization. WHO treatment guidelines for drug-resistant tuberculosis, 2016 update.
46. Sharma JB, Sneha J, Singh UB, Kumar S, Roy KK, Singh N, et al. Comparative study of laparoscopic abdominopelvic and fallopian tube findings before and after antitubercular therapy in female genital tuberculosis with infertility. J Minim Invasive Gynecol, 2016; 23(2): 215-22.
47. Kulshrestha V, Kriplani A, Agarwal N, Singh UB, Rana T. Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy. Int J Gynaecol Obstet, 2011; 113(3): 229-34.
48. Naredi N, Talwar P, Narayan N, Rai S, Vardhan S, Panda S. Spontaneous conception following anti-tubercular treatment for sub-fertile women with multiple imaging markers suggesting genital tuberculosis. Fertil Sci Res, 2014; 1(1): 44-9.
49. Sutherland AM. Surgical treatment of tuberculosis of the female genital tract. Br J Obstet Gynaecol, 1980; 87(7): 610-2.
50. Sharma JB, Mohanraj P, Roy KK, Jain SK. Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis. Int J Gynaecol Obstet, 2010; 109(3): 242-4.
51. Singh N, Sharma AK, Dadhwal V, Gupta N, Mittal S. Postoperative flare-up of genital tuberculosis: a clinical reality. Int J Tuberc Lung Dis, 2009; 12(8): 981-3.
52. World Health Organization. WHO Global Tuberculosis Report 2017.
53. Kumar S, Sharma JB. Female Genital Tuberculosis. In: Sharma SK, Mohan A, eds. Tuberculosis. Delhi. Jaypee, 2016: 311-24.
54. Diken ÖE. Tüberkülozdan Korunma. In: Şimşek H, Gülhan M, Özkan AT, eds. Her Yönüyle Tüberküloz. Ankara. Hipokrat, 2019: 355-70
55. Tripathy SN, Tripathy SN. Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynaecol Obstet, 2002; 76(2): 159-63.

A global overview of genital tuberculosis from gynecologist’s respect

Year 2020, Volume: 77 Issue: 2, 253 - 266, 01.06.2020

Ümit Görkem Sertaç Arslan

Abstract

Tuberculosis TB is one of the most common 10 diseases that affect millions of people and result in death all over the world. Nowadays, there has been a significant decrease in mortality rates due to the improvement in TB diagnosis and effective treatment methods. However, TB is still a public health problem that remains important. TB is still among the most common non-obstetric causes of maternal mortality in the developing countries. Genital tuberculosis GTB is considered to be one of the important causes of infertility, pelvic pain, chronic pelvic inflammatory disease, dyspareunia and abnormal uterine bleeding. Therefore, negative consequences of GTB can be prevented or minimized by early diagnosis, appropriate and effective treatment. GTB often develops secondary to pulmonary TB or extrapulmonary TB foci in the kidneys, meninges, skeletal system and gastrointestinal system. The TB bacillus infects the genital system in 4 ways: 1- Hematogenous spread, 2-Lymphatic spread, 3- Descending direct spread, 4Primary infection of the genitalia with sexual intercourse. In addition, the disease can be spread by the peritoneal dialysis in renal failure. The genital organs affected by GTB, in the order of frequency are; Fallopian tubes 90-100% , uterine endometrium 50-60% , cervix 515% , uterine myometrium 2-5% , vulva and vagina 1genital sistemde tubal hasara ve bozulmuş endometrial reseptiviteye yol açarak infertiliteye neden olmaktadır. İntrauterin yapışıklıklar, menstrüel anormallikler ve bozulmuş endometrial reseptivite ile sonuçlanan endometrium hasarı, tekrarlayan gebelik kayıpları ve ektopik gebelik risklerini artırmaktadır. Ayrıca pelvik kitlelerin değerlendirilmesinde GTB de ayırıcı tanıda göz ardı edilmemelidir. GTB’li infertil hastalarda en gerçekçi tedavi yaklaşımı, gebelik sonuçlarının çok olumlu olmamasına rağmen, endometriumun değerlendirilmesini takiben hastanın yardımla üreme tekniklerine yönlendirilmesi gerekebilmektedir. Yüksek risk popülasyonlarının uygun taranma prosedürleri jinekolojik, obstetrik ve reprodüktif olumsuz sonuçların önlenmesi ve TB eradikasyonu için son derece önem taşımaktadır. Tüm dünyada olduğu gibi Türkiye’de de son yıllarda göçmenlerin sayısı hızlı bir şekilde artmaktadır. Dolayısı ile günümüzde unutulmuş bir hastalık gibi görülen TB klinik pratiğimizde akılda tutulmalıdır

Keywords

Tuberculosis, female genital, infertility, Mycobacterium tuberculosis

References

1. World Health Organization. Facts about health in African Subregion, Fact sheet N◦314 World Health Organisation, 2011.
2. World Health Organization. Global Tuberculosis Report 2018. Geneva: World Health Organization; 2018.
3. Grange J, Adhikari M, Ahmed Y, Mwaba P, Dheda K, Hoelscher M, et al. Tuberculosis in association with HIV/AIDS emerges as a major nonobstetric cause of maternal mortality in Sub-Saharan Africa. Int J Gynaecol Obstet, 2010; 108: 181- 3.
4. Neonakis IK, Spandidos DA, Petinaki E. Female genital tuberculosis: A review. Scand J Infect Dis, 2011; 43(8): 564-72.
5. Sharma JB. Tuberculosis and Gynecological Practice. In: Studd J, Tan SL, Chervenak FA, eds. Current Progress in Obstetric and Gynecology. Mumbai. Tree Life India, 2012: 304-27.
6. Jones HW, Wentz AC, Burnett LS. Novak’s Textbook of Gynecology, 11th ed. Baltimore: 1988.
7. Arora VK. Relevance of DOTS strategy in female genital tuberculosis. Obstet Gynecol Today, 2002; 7: 179-83.
8. Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician, 2005; 72: 1761–8.
9. Margolis K, Wranz PA, Kruger TF, Joubert JJ, Odendaal HJ. Genital tuberculosis at Tygerberg Hospital- Prevalence, clinical presentation and diagnosis. S Afr Med J, 1992; 81(1): 12-5.
10. Saracoglu OF, Mungan T, Tanzer F. Pelvic tuberculosis. Int J Gynaecol Obstet, 1992; 37(1): 115-20.
11. Lawn SD, Zumla AI. Tuberculosis. Lancet. 2011; 378: 57-72.
12. Oosthuizen AP, Wessels PH, Hefer JN. Tuberculosis of the female genital tract in patients attending an infertility clinic. S Afr Med J, 1990; 77(11): 562-4.
13. Sağlık Bakanlığı. Türkiye’de Verem Savaşı 2018 Raporu.
14. Sağlık Bakanlığı. Türkiye’de Verem Savaşı 2011 Raporu.
15. Sharma JB. Current diagnosis and management of female genital tuberculosis. J Obstet Gynaecol India, 2015; 65(6): 362-71.
16. TB India. Revised National Tuberculosis Control Program (RNTCP). Annual Status Report. Central TB Division, Directorate General of Health Services. Nirman Bhawan, New Delhi, India: Ministry of Health and Family Welfare; 2016.
17. Parikh FR, Nadkarni S. Genital tuberculosis- a major pelvic factor causing infertility in Indian women. Fertil Steril, 1997; 67(3): 497-500.
18. Figueiredo AA, Lucon AM, Srougi M. Urogenital Tuberculosis. Microbiol Spectr, 2017; 5(1).
19. Ilhan AH, Durmuşoğlu F. Case report of a pelvic-peritoneal tuberculosis presenting as an adnexial mass and mimicking ovarian cancer, and a review of the literature. Infect Dis Obstet Gynecol, 2004; 12(2): 87-9.
20. Namavar Jahromi B, Parsanezhad ME, GhaneShirazi R. Female genital tuberculosis and infertility. Int J Gynaecol Obstet, 2001; 75(3): 269-72.
21. Sharma JB. In vitro fertilization and embryo transfer in female genital tuberculosis. IVF Lite, 2015; 2(1): 14-25
22. Bose M. Female genital tract tuberculosis: How long will it elude diagnosis? Indian J Med Res, 2011; 134: 13-4.
23. Chowdhury NN. Overview of tuberculosis of the female genital tract. J Indian Med Assoc, 1996; 94(9): 345-6, 361.
24. Raut VS, Mahashur AA, Sheth SS. The Mantoux test in the diagnosis of genital tuberculosis in women. Int J Gynaecol Obstet, 2001; 72(2): 165-9.
25. Lange C, Pai M, Drobniewski F, Migliori GB. Interferon-gamma release assays for the diagnosis of active tuberculosis: Sensible or silly? Eur Respir J, 2009; 33(6): 1250-3.
26. Pai M, Joshi R, Bandyopadhyay M, Narang P, Dogra S, Taksande B, et al. Sensitivity of a whole-blood interferon-gamma assay among patients with pulmonary tuberculosis and variations in T-cell responses during antituberculosis treatment. Infection, 2007; 35(2): 98-103.
27. Saraswat P, Swarankar ML, Bhandari A, Soni RR. Detection of active female genital tuberculosis by molecular method. Int J Pharma Bio Sci. 2010; 1(4).
28. Bhanu NV, Singh UB, Chakraborty M, et al. Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility. J Med Microbiol , 2005; 54(Pt 10): 927-31.
29. Lal N, Soto-Wright V. Peritoneal tuberculosis: Diagnostic options. Infect Dis Obstet Gynecol, 1999; 7(5): 244-7.
30. Straughn JM, Robertson MW, Partridge EE. A patient presenting with a pelvic mass, elevated Ca-125 and fever. Gynecol Oncol, 2000; 77(3): 471-2.
31. Sutherland AM. Gynaecological tuberculosis: analysis of a personal series of 710 cases. Aust N Z J Obstet Gynecol, 1985; 25(3): 203-7.
32. Sharma JB, Pushparaj M, Roy KK, Neyaz Z, Gupta N, Jain SK, et al. Hysterosalpingographic findings in infertile women with genital tuberculosis. Int J Gynecol Obstet, 2008; 101(2): 150-5.
33. Shah HU, Sannananja B, Baheti AD, Udare AS, Badhe PV. Hysterosalpingography and ultrasonography findings of female genital tuberculosis. Diagn Interv Radiol, 2015; 21(1): 10-5.
34. Ahmadi F, Zafarani F, Shahrzad G. Hysterosalpingographic appearances of female genital tract tuberculosis: Part I. Fallopian tube. Int J Fertil Steril, 2014; 7(4): 245-52.
35. Ahmadi F, Zafarani F, Shahrzad GS. Hysterosalpingographic appearances of female genital tract tuberculosis: Part II: Uterus. Int J Fertil Steril, 2014; 8(1): 13-20.
36. Farrokh D, Layegh P, Afzalaghaee M, Mohammadi M, Fallah Rastegar Y. Hysterosalpingographic findings in women with genital tuberculosis. Iran J Reprod Med, 2015; 13(5): 297-304.
37. World Health Organization. Manual of diagnostic ultrasound. Geneva: WHO; 2013.
38. Sharma JB, Roy KK, Pushparaj M, Kumar S, Malhotra N, Mittal S. Laparoscopic findings in female genital tuberculosis. Arch Gynecol Obstet, 2008; 278(4): 359-64.
39. Baxi A, Neema H, Kaushal M, Sahu P, Baxi D. Genital tuberculosis in infertile women: Assessment of endometrial TB PCR results with laparoscopic and hysteroscopic features. J Obstet Gynecol India, 2011; 61(3): 301-6.
40. Koc S, Beydilli G, Tulunay G, Ocalan R, Boran N, Ozgul N, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol, 2006; 103(2): 565-9.
41. Chong VH, Rajendran N. Tuberculosis peritonitis in Negara Brunei Darussalam. Ann Acad Med Singapore, 2005; 34(9): 548-52.
42. Bilgin T, Karabay A, Dolar E, Develioglu OH. Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: a series of 10 cases. Int J Gynecol Cancer, 2001;11(4): 290-4.
43. Kuohung W, Borgatta L, Larrieux JR, Weiss RM. Pelvic tuberculosis diagnosed by hysteroscopy during infertility evaluation. J Assist Reprod Genet, 2000; 17(8): 459-60.
44. Sharma JB, Roy KK, Pushparaj M, Karmakar D, Kumar S, Singh N. Increased difficulties and complications encountered during hysteroscopy in women with genital tuberculosis. J Minim Invasive Gynecol, 2011; 18(5): 660-5.
45. World Health Organization. WHO treatment guidelines for drug-resistant tuberculosis, 2016 update.
46. Sharma JB, Sneha J, Singh UB, Kumar S, Roy KK, Singh N, et al. Comparative study of laparoscopic abdominopelvic and fallopian tube findings before and after antitubercular therapy in female genital tuberculosis with infertility. J Minim Invasive Gynecol, 2016; 23(2): 215-22.
47. Kulshrestha V, Kriplani A, Agarwal N, Singh UB, Rana T. Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy. Int J Gynaecol Obstet, 2011; 113(3): 229-34.
48. Naredi N, Talwar P, Narayan N, Rai S, Vardhan S, Panda S. Spontaneous conception following anti-tubercular treatment for sub-fertile women with multiple imaging markers suggesting genital tuberculosis. Fertil Sci Res, 2014; 1(1): 44-9.
49. Sutherland AM. Surgical treatment of tuberculosis of the female genital tract. Br J Obstet Gynaecol, 1980; 87(7): 610-2.
50. Sharma JB, Mohanraj P, Roy KK, Jain SK. Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis. Int J Gynaecol Obstet, 2010; 109(3): 242-4.
51. Singh N, Sharma AK, Dadhwal V, Gupta N, Mittal S. Postoperative flare-up of genital tuberculosis: a clinical reality. Int J Tuberc Lung Dis, 2009; 12(8): 981-3.
52. World Health Organization. WHO Global Tuberculosis Report 2017.
53. Kumar S, Sharma JB. Female Genital Tuberculosis. In: Sharma SK, Mohan A, eds. Tuberculosis. Delhi. Jaypee, 2016: 311-24.
54. Diken ÖE. Tüberkülozdan Korunma. In: Şimşek H, Gülhan M, Özkan AT, eds. Her Yönüyle Tüberküloz. Ankara. Hipokrat, 2019: 355-70
55. Tripathy SN, Tripathy SN. Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynaecol Obstet, 2002; 76(2): 159-63.

There are 55 citations in total.

Details

Primary Language	Turkish
Journal Section	Collection
Authors	Ümit Görkem This is me Sertaç Arslan This is me
Publication Date	June 1, 2020
Published in Issue	Year 2020 Volume: 77 Issue: 2

Cite

APA	Görkem, Ü., & Arslan, S. (2020). Jinekolog gözüyle genital tüberküloza global bakış. Türk Hijyen Ve Deneysel Biyoloji Dergisi, 77(2), 253-266.
AMA	Görkem Ü, Arslan S. Jinekolog gözüyle genital tüberküloza global bakış. Turk Hij Den Biyol Derg. June 2020;77(2):253-266.
Chicago	Görkem, Ümit, and Sertaç Arslan. “Jinekolog gözüyle Genital tüberküloza Global bakış”. Türk Hijyen Ve Deneysel Biyoloji Dergisi 77, no. 2 (June 2020): 253-66.
EndNote	Görkem Ü, Arslan S (June 1, 2020) Jinekolog gözüyle genital tüberküloza global bakış. Türk Hijyen ve Deneysel Biyoloji Dergisi 77 2 253–266.
IEEE	Ü. Görkem and S. Arslan, “Jinekolog gözüyle genital tüberküloza global bakış”, Turk Hij Den Biyol Derg, vol. 77, no. 2, pp. 253–266, 2020.
ISNAD	Görkem, Ümit - Arslan, Sertaç. “Jinekolog gözüyle Genital tüberküloza Global bakış”. Türk Hijyen ve Deneysel Biyoloji Dergisi 77/2 (June 2020), 253-266.
JAMA	Görkem Ü, Arslan S. Jinekolog gözüyle genital tüberküloza global bakış. Turk Hij Den Biyol Derg. 2020;77:253–266.
MLA	Görkem, Ümit and Sertaç Arslan. “Jinekolog gözüyle Genital tüberküloza Global bakış”. Türk Hijyen Ve Deneysel Biyoloji Dergisi, vol. 77, no. 2, 2020, pp. 253-66.
Vancouver	Görkem Ü, Arslan S. Jinekolog gözüyle genital tüberküloza global bakış. Turk Hij Den Biyol Derg. 2020;77(2):253-66.

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